How to Use the Bishop Score to Determine Induction Success

Written by heidi gonzales

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Use the Bishop Score to Determine Induction Success

The bishop score is a score that some doctors and midwives use to determine how favorable your body is for a successful labor induction. This score tallies a number in five different areas including position of cervix, consistency of cervix, effacement, dilation and station of baby. Once individual scores are given, a composite score is tallied and then an informed decision can be made. A higher score is more favorable for a successful induction. Here is how to understand the bishop score.

Skill level:

Moderate

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Instructions

1

If your doctor begins mentioning induction as a possibility, you need to ask about your bishop score. Determining this score could either deter you from having the induction or assure you that it will likely be successful.

2

If you feel that your doctor is not open to the bishop score method, you can follow the steps below to determine your own score and make an informed decision. It is a good idea to bring a pad and pen to write down the numbers that he will give you.

3

Keep in mind that you will not be asking for any special numbers. When your doctor does a vaginal exam, she automatically checks for the things that are used to calculate the bishop score. She will be feeling for the position of the cervix, the consistency of the cervix, effacement, dilation and station of the baby.

4

The first thing the doctor will generally check for is the position of your cervix. If it is posterior, meaning still tilted to the back, he will assign a 0. If the cervix is between posterior and anterior, he will assign a 1. If the cervix is anterior, meaning that it is tilted to the front, he will assign a 2. The more anterior your cervix is, the more favorable for induction.

5

The second thing the doctor will feel for is the consistency of the cervix. If the cervix still feels firm, like the tip of a nose, the score is 0. If the cervix is between firm and soft, the score is 1. If the cervix feels soft, like the tip of a tongue, the score is 2. The softer the cervix, the more favorable it is for induction.

6

The third thing the doctor will check for is effacement. Effacement is the thinning of the cervix and is measured in percentages from 0 to 100 percent, with 100 being completely effaced. If the cervix is effaced 0 to 30 percent, the score is 0. If the cervix is effaced 40 to 50 percent, the score is 1. If the cervix is effaced 60 to 70 percent, the score is 2. If the cervix is effaced 80 percent or more, the score is 3. Again, the more effaced your cervix is, the more favorable for induction.

7

The fourth thing the doctor will check for is dilation. Dilation is measured in centimeters from 1 to 10 centimeters, with 10 centimeters being completely dilated. If the cervix is closed, the score is 0. If the cervix is 1 to 2 centimeters, the score is 1. If the cervix is 3 to 4 centimeters, the score is 2. If the cervix is dilated 5 centimeters or more, the score is 3. It is important to note that if your cervix is dilated to 5 centimeters or more, induction isn't necessary unless medically indicated.

8

The fifth thing that will be assessed is the station of the baby. Station is measured by the top of the baby's presenting part in relation to the ischial spines on the mother's pelvis. If the baby's head is above the ischial spines, it is ranked in the negative numbers. If the head is even with the spines, it is considered a 0 station. If the head is past the ischial spines and into the birth canal, it is ranked in positive numbers. If during assessment the head is at -3, the score will be 0. If the head is -2, the score is 1. If the head is -1 to 0, the score is 2. If the head is +1 to +2, the score is 3. The lower the head is, indicated by positive numbers, the more favorable for induction.

9

Consider the following modifiers after the other five criteria are met. You will add one point if you have preeclampsia or for each vaginal delivery you've had. You will subtract one point for a post-date pregnancy, if this is your first pregnancy or you have premature rupture of membranes.

10

After all of these points are added together you can determine whether or not your body is favorable for an induction. A score over 8 means that your body is more than likely favorable for an induction. It does not guarantee that an induction will work, but the conditions are favorable. If your score is lower than 8 you have to consider the risks and benefits of an induction more closely. If your bishop score is under 3, do not proceed with an induction unless it's medically indicated.

Tips and warnings

Always discuss alternative options with your doctor.

Learn about the risks and benefits of an induction before making a decision.

Talk to your doctor about the various ways of inducing, and which method is safer.